This invention relates to a method and apparatus for performing surgical procedures. It is particularly adapted to arthroscopic surgery for reconstruction of anterior cruciate ligaments, but certain features may be applicable to nonarthroscopic surgery of the knee or arthroscopic surgery of other sites such as the shoulder.
Various techniques have evolved for anterior cruciate ligament surgery. Most but not all procedures involve the forming of an incision in the thigh, and the insertion of a drill through the thigh incision to drill a hole through the femur. Similarly, a lower incision is made to permit the drilling of a hole in the proximal end of the tibia. The replacement graft, either natural or artificial, is connected to a passing member which is threaded through the femoral and tibial holes, and the graft is pulled into position where it is properly fixed.
In an alternative type of anterior cruciate ligament surgery developed by Thomas D. Rosenberg, all drilling is done through an incision below the knee, including the drilling of a blind hole in the femur. A patellar tendon graft, held by a bone grasper, is inserted first through the tibial hole and then into the femoral hole. The proximal end of the graft is fixed to the femur by a fixation screw.
In a technique disclosed by Watanabe's U.S. Pat. No. 4,946,462, anterior cruciate ligament reconstructive surgery is performed by forming an incision in the thigh, feeding a graft-engaging passing member up through holes in the tibia and femur, and through the thigh incision. The graft is connected to the passing member which is then pulled in a distal direction until it is at the desired position where it is fixed in place.
The present invention varies from the prior art in several respects which are believed to provide distinct advantages. Operative time is decreased. No anterior thigh incision is required. Graft-receiving bores in the tibia and femur do not have to be perfectly aligned. If it becomes necessary to remove a graft after it is initially positioned at the site, it is not necessary to rethread the graft-passing wire in order to reinsert the graft.
One feature of the invention involves the procedure and tools for forming the femoral hole and for positioning a graft-passing member so that it extends through the hole as to have a midportion extending through the joint, a proximal portion extending from and accessible above the thigh, and a distal portion below the knee. Thus, a graft can be moved into position, withdrawn, and then moved back into position without rethreading the graft-passing wire through the tibia and femur. The invention also involves a technique for puncturing tissue after drilling through a bone in a manner which provides directional movement of the puncturing device to control the location where it exits the body. Various other features involve a member which serves both as a drill bit and a wire-guiding member, an obturator which prevents matter from entering a bore in the drill bit, a stop member which is attachable to the passing wire and has dimensions which prevent it from entering the femoral hole, a rotary-bone cutting tool which is moved to and advanced at a femoral drilling site by tension on a guide wire, and a flexible container filled with radiopaque fluid which is passed to the surgical site by a guide wire to permit visualization of the shapes of bores formed for receiving the opposite ends of the graft. Most importantly, however, the wire is connectable to a replacement ligament so that the ligament may be moved in opposite directions to and from its desired site.